Provider Demographics
NPI:1609684406
Name:KING & MILES FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:KING & MILES FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-430-6023
Mailing Address - Street 1:2038 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1561
Mailing Address - Country:US
Mailing Address - Phone:812-473-1128
Mailing Address - Fax:812-473-3850
Practice Address - Street 1:2038 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1561
Practice Address - Country:US
Practice Address - Phone:812-473-1128
Practice Address - Fax:812-473-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty